PURPOSE:To determine the association between device-determined diagnostic indices, including intrathoracic impedance, and heart failure (HF) hospitalization. METHODS:Clinical and device diagnostic data of 558 HF patients indicated for CRT-D therapy (In Sync Sentry, Medtronic Inc.) were prospectively collected from 34 centers. Device-recorded intrathoracic impedance fluid index threshold crossing event (TCE), mean activity counts, tachyarrhythmia events, night heart rate (NHR) and heart rate variability (HRV) were compared within patients with vs. without documented HF hospitalization. RESULTS:Mean follow-up was 326 +/- 216 days. Patients hospitalized for HF had significantly higher rates of TCE, a higher percentage of days with the thoracic impedance fluid index above the programmed threshold, a higher percentage of days with low activity, with low HRV or with high NHR. Multivariate analysis showed that TCE resulted in a 36% increased probability of HF hospitalization. Both TCE duration and patient activity were also significantly associated with hospitalization. Kaplan Meier analysis indicated that patients with more TCE events were significantly more likely to be hospitalized (log rank test, p = 0.005). CONCLUSIONS:Decreased intrathoracic impedance, low patient activity and low HRV were all independently associated with increased risk for HF hospitalization in HF patients treated with resynchronization therapy. Device-derived diagnostic data may provide valuable and reliable indices for the prognostic stratification of HF patients.

译文

目的:确定设备确定的诊断指标(包括胸内阻抗)与心力衰竭(HF)住院之间的关联。
方法:前瞻性地从34个中心收集了558例接受CRT-D治疗的HF患者的临床和设备诊断数据(在Sync Sentry,Medtronic Inc.)。比较有记录和无记录的心衰住院患者的设备记录的胸内阻抗液指数阈值穿越事件(TCE),平均活动计数,心律失常事件,夜间心率(NHR)和心率变异性(HRV)。
结果:平均随访时间为326 /-216天。 HF住院的患者的TCE率显着更高,胸阻抗液指数高于设定的阈值的天数百分比更高,活动量低,HRV较低或NHR较高的天数百分比更高。多变量分析表明,TCE导致HF住院的可能性增加了36%。 TCE持续时间和患者活动均与住院密切相关。 Kaplan Meier分析表明,发生更多TCE事件的患者住院的可能性明显更高(log rank测试,p = 0.005)。
结论:重新同步治疗的心衰患者,胸内阻抗的降低,患者活动度的降低和心率变异性的降低均与心衰住院的风险增加有关。设备衍生的诊断数据可为HF患者的预后分层提供有价值和可靠的指标。

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